Saturday, August 21, 1999
HIV fighter gives condoms to prostitutes
CDC funds effort to slow epidemic
BY SUSAN VELA
The Cincinnati Enquirer
In Northern Kentucky, there is a health educator who visits parks, parking lots and riverfront property to pass out condoms to those practicing high-risk — and potentially deadly — sex.
Dan Newman is receiving national recognition for his street outreach, which is funded by the Atlanta-based Centers for Disease Control and Prevention (CDC), and advising other educators interested in starting similar programs in rural regions of Indiana, Iowa, Colorado and South Dakota.
Mr. Newman's goal is to promote HIV testing — HIV is the AIDS-causing virus — to men and women who sell themselves.
But he acknowledged that his tactics with this population are as controversial as needle-exchange programs.
“These activities have always been there with or with out condoms (and) it's still going to happen whether we're there or not,” said Mr. Newman, of the Northern Kentucky Independent District Health Department (NKIDHD), which serves Kenton, Campbell, Boone and Grant counties. “Either we distribute condoms and make a dent in the (AIDS) epidemic or we don't and we don't get the funding.
“When you have funding coming in from CDC and in
order to get that funding you have to distribute condoms, you do it.”
CDC officials have been reporting that AIDS cases in rural and suburban communities (nonmetropolitan areas with populations less than 50,000) are accelerating at one of the fastest rates.
Since the beginning of the epidemic, they have comprised 5.6 percent of the 641,000 total cases reported. The percentage jumped from 6.6 percent of the total cases reported in 1996 to 7.2 percent for 1997.
The Public Sexual Encounters program (PSE) in Northern Kentucky is based on an effort that began about 10 years ago in California. Its intent was to target the high-risk men who do not frequent gay bars and support groups but still seek out sex with other men.
Mr. Newman was working at AIDS Volunteers of Cincinnati when he heard of it and helped that agency start its own program, which targeted some Cincinnati parks and a central downtown area.
He modified the initiative to Northern Kentucky's more rural clime in 1995, soon after he joined NKIDHD, and has helped modify a PSE training manual that has been used at the state level.
CDC funds the effort for about $40,000 a year. Most of the money goes to salary and administration costs. Between $1,000 and $2,000 is budgeted for condoms and discounted food coupons.
Sometimes he can make contact with 18 people in three hours and sometimes he doesn't make any contact at all.
When he sees familiar faces, he tries to build trust and hands out literature, food coupons and sometimes condoms. The latter, he said, can be expensive for some of these people who are hustling their bodies for quick cash.
For faces he's never seen before, he makes eye contact or smiles. If they approach, he lets them know within five minutes about why he's there and his work with the health department.
Tim Roe, rural HIV prevention coordinator for the Ohio Health Department, said one popular misconception is that PSE programs calling for condom distribution are promoting high-risk behavior.
“It's about what's going on and how to effectively approach an education program,” he said. “Does that put them at risk? If anything, it's an effective deterrent.”
A first-ever survey of PSE programs in Kentucky showed that 1,659 contacts were made with the high-risk target groups in 1998. Seventy-three percent reported that they have had an HIV test.
Survey results from Northern Kentucky show 346 contacts were made in Kenton, Campbell, Boone and Grant counties last year and that 1,248 condoms were disbursed in that region. There were 995 food coupons passed out.
Mr. Newman thinks the statistics indicate the program's success. HIV educators are promoting HIV tests to the people who normally wouldn't be targeted but need testing the most, he said.
Newport Sgt. Jerry Roy sees holes in the effort. He met Mr. Newman years ago, when the latter was visiting the region's police departments and talking about the health district's new effort.
Sgt. Roy would like to see some hard data proving that street outreach and condom handouts are halting the spread of HIV.
Without such facts, he wonders what good free condoms are doing for people who put themselves at risk of being robbed or murdered every time they pursue sex with strangers.
If they don't care about those other dangers, then they certainly don't care about getting HIV, he said.
Mr. Newman isn't naive.
“I'd like to think we'd have 100 percent usage rate, but we know it's not going to happen,” he said.
Mr. Newman believes that about half of his contacts eventually get tested for HIV. But he concedes that there's no way to verify that.
All he has is the word of his contacts. And he realizes they're not the most trustworthy.
“At least by our presence, it's giving (these) people the chance to be educated,” he said. “That's the whole goal of the program: Education.”
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